NSG 552 Exam 2 Psychopharmacology
(2026/2027) PDF | Nursing | Wilkes University
1. A patient’s CYP450 2D6 poor metabolizer phenotype
is confirmed. Which antidepressant would require the
largest dose reduction to avoid toxicity?
A) Escitalopram
B) Sertraline
C) Fluoxetine
D) Citalopram
Answer: C) Fluoxetine
Rationale: Fluoxetine and its active metabolite
norfluoxetine are potent CYP2D6 inhibitors. In a poor
metabolizer, fluoxetine levels rise significantly, increasing
risk of serotonin toxicity. Escitalopram and citalopram are
less dependent on 2D6; sertraline affects 2D6 mildly.
2. The therapeutic index of lithium is narrow. A toxic level
is generally considered:
A) >0.6 mEq/L
1
,B) >1.2 mEq/L
C) >1.5 mEq/L
D) >2.0 mEq/L
Answer: C) >1.5 mEq/L
Rationale: Acute toxicity >1.5 mEq/L; severe
toxicity >2.0 mEq/L. Therapeutic range: 0.6–1.2 mEq/L
for acute mania, 0.6–0.8 for maintenance.
3. Which medication requires baseline and periodic ECG
monitoring due to risk of QT prolongation?
A) Bupropion
B) Venlafaxine
C) Citalopram (above 40 mg)
D) Mirtazapine
Answer: C) Citalopram (above 40 mg)
Rationale: FDA warning: citalopram >40 mg/day causes
dose-dependent QT prolongation (risk of torsade de
pointes). Venlafaxine and mirtazapine have minimal QT
effects; bupropion has no significant QT effect.
2
,4. A patient on an MAOI eats aged cheese and develops
hypertensive crisis. First-line treatment is:
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
Answer: B) Phentolamine
Rationale: Phentolamine (5 mg IV) is an alpha-1
antagonist used for MAOI-induced hypertensive crisis.
Propranolol can worsen unopposed alpha stimulation.
5. Which anticonvulsant used as a mood stabilizer
requires HLA-B*1502 screening in Asian patients?
A) Valproate
B) Lamotrigine
C) Oxcarbazepine
D) Carbamazepine
Answer: D) Carbamazepine
Rationale: HLA-B*1502 allele strongly predicts Stevens-
3
, Johnson syndrome/TEN with carbamazepine in Han
Chinese, Thai, and other Asian populations.
6. The primary mechanism of action of SSRIs is:
A) Blockade of presynaptic dopamine receptors
B) Inhibition of serotonin reuptake pump
C) Antagonism of 5-HT2A receptors
D) Enhancement of GABA activity
Answer: B) Inhibition of serotonin reuptake pump
Rationale: SSRIs selectively bind SERT, increasing synaptic
serotonin. They do not directly block dopamine or GABA.
7. Which medication is most likely to cause a false-
positive urine amphetamine screen?
A) Quetiapine
B) Bupropion
C) Trazodone
D) Lamotrigine
Answer: B) Bupropion
Rationale: Bupropion (and some other antidepressants)
4
(2026/2027) PDF | Nursing | Wilkes University
1. A patient’s CYP450 2D6 poor metabolizer phenotype
is confirmed. Which antidepressant would require the
largest dose reduction to avoid toxicity?
A) Escitalopram
B) Sertraline
C) Fluoxetine
D) Citalopram
Answer: C) Fluoxetine
Rationale: Fluoxetine and its active metabolite
norfluoxetine are potent CYP2D6 inhibitors. In a poor
metabolizer, fluoxetine levels rise significantly, increasing
risk of serotonin toxicity. Escitalopram and citalopram are
less dependent on 2D6; sertraline affects 2D6 mildly.
2. The therapeutic index of lithium is narrow. A toxic level
is generally considered:
A) >0.6 mEq/L
1
,B) >1.2 mEq/L
C) >1.5 mEq/L
D) >2.0 mEq/L
Answer: C) >1.5 mEq/L
Rationale: Acute toxicity >1.5 mEq/L; severe
toxicity >2.0 mEq/L. Therapeutic range: 0.6–1.2 mEq/L
for acute mania, 0.6–0.8 for maintenance.
3. Which medication requires baseline and periodic ECG
monitoring due to risk of QT prolongation?
A) Bupropion
B) Venlafaxine
C) Citalopram (above 40 mg)
D) Mirtazapine
Answer: C) Citalopram (above 40 mg)
Rationale: FDA warning: citalopram >40 mg/day causes
dose-dependent QT prolongation (risk of torsade de
pointes). Venlafaxine and mirtazapine have minimal QT
effects; bupropion has no significant QT effect.
2
,4. A patient on an MAOI eats aged cheese and develops
hypertensive crisis. First-line treatment is:
A) Naloxone
B) Phentolamine
C) Flumazenil
D) Propranolol
Answer: B) Phentolamine
Rationale: Phentolamine (5 mg IV) is an alpha-1
antagonist used for MAOI-induced hypertensive crisis.
Propranolol can worsen unopposed alpha stimulation.
5. Which anticonvulsant used as a mood stabilizer
requires HLA-B*1502 screening in Asian patients?
A) Valproate
B) Lamotrigine
C) Oxcarbazepine
D) Carbamazepine
Answer: D) Carbamazepine
Rationale: HLA-B*1502 allele strongly predicts Stevens-
3
, Johnson syndrome/TEN with carbamazepine in Han
Chinese, Thai, and other Asian populations.
6. The primary mechanism of action of SSRIs is:
A) Blockade of presynaptic dopamine receptors
B) Inhibition of serotonin reuptake pump
C) Antagonism of 5-HT2A receptors
D) Enhancement of GABA activity
Answer: B) Inhibition of serotonin reuptake pump
Rationale: SSRIs selectively bind SERT, increasing synaptic
serotonin. They do not directly block dopamine or GABA.
7. Which medication is most likely to cause a false-
positive urine amphetamine screen?
A) Quetiapine
B) Bupropion
C) Trazodone
D) Lamotrigine
Answer: B) Bupropion
Rationale: Bupropion (and some other antidepressants)
4
